Vaccination Coverage in Adults Remains Low, Says CDC

Adult vaccination coverage increased slightly overall in 2010 compared with 2009 but remains low and shows little progress in meeting Healthy People 2020 targets. That's according to CDC-analyzed data from the 2010 National Health Interview Survey.

The CDC analysis(www.cdc.gov), which was published Feb. 3 in Morbidity and Mortality Weekly Report, reported increases in coverage for tetanus, diphtheria and acellular pertussis vaccine in people ages 19-64 (a 1.6 percent increase to 8.2 percent); herpes zoster vaccine among people 60 and older (a 4.4 percent increase to 14.4 percent); and one or more doses of human papillomavirus (HPV) vaccine in women ages 19-26 (a 3.6 percentage point increase to 20.7 percent).

Coverage rates for pneumococcal and hepatitis B vaccines remained virtually unchanged, while hepatitis A vaccine coverage ticked up only slightly among people ages 19-49. Influenza vaccination coverage estimates(www.cdc.gov) for the 2010-11 season were published separately.

Jamie Loehr, M.D., of Ithaca, N.Y., the AAFP's liaison to the CDC's Advisory Committee on Immunization Practices (ACIP), attributes the low coverage rates to a culture in which adults think they don't need vaccines.

Coverage rates for pneumococcal, hepatitis A and hepatitis B vaccines remained largely unchanged during that period.

"Most adults are not in high-risk groups, so the only vaccine they think they need is a tetanus shot every 10 years," he said.

Vaccine cost also could be a contributing factor to the low coverage, Loehr told AAFP News Now.

According to the Patient Protection and Affordable Care Act(www.healthcare.gov), public insurers and new private health plans (i.e., those established on or after Sept. 23, 2010) are required to cover all ACIP-approved vaccines without cost-sharing. Insurance plans established before that date received grandfather status and are not required to cover such recommended preventive services unless they make significant plan changes that reduce benefits or increase costs to consumers.

Still, cost is only part of the adult vaccination picture, as evidenced by the fact that some of the more expensive vaccines, including the herpes zoster and HPV vaccines, actually saw modest increases in 2010.

Overall, adult vaccination coverage is much lower than children's vaccination coverage, which is about 90 percent for most longstanding recommended vaccines, according to a CDC report(www.cdc.gov) published last year.

That's likely because almost all children have a person they identify as their doctor -- the person they see for checkups -- who ensures they are vaccinated appropriately, said Loehr.

"Adult care is more fragmented," he noted. "Many adults are healthy and don't have a doctor."